‘APPs’ Work Collaboratively to Enhance Access to Care

When Thompson Health Assistant Medical Director of Associate Health John Oliphant first became a physician assistant (PA) in 1996, there were approximately 80 accredited PA programs in the U.S. Today, there are over 300.

“The popularity is through the roof,” John said, noting, however, that admission to the programs is still highly competitive.

The five-fold increase in PA programs is just one indication of the demand for advanced practice providers (APPs), a term encompassing physician assistants, nurse practitioners (NPs), certified nurse midwives, certified registered nurse anesthetists, and clinical nurse specialists.

APP ranks as one of LinkedIn’s top “Jobs on the Rise.” When U.S. News & World Report announced its annual list of “Best Health Care Jobs” this past January, NP and PA were the top two, respectively. Both were in the top five on the “100 Best Jobs” overall list. Meanwhile, the 2022 Advanced Practice Provider Strategy & Oversight Survey – which involved more than 60 organizations representing more than 3,000 APPs – found that 74% have a strategy to increase the use of APPs when it comes to patients seeking primary care.

Within Thompson Health, there are more than 80 APPs and growing. As a reflection of their increasing role in the delivery of healthcare locally, the health system recently created a new position: Director of Advanced Practice. Family Nurse Practitioner Christina D’Agostino was named to the position and continues as an NP in nephrology at Thompson while overseeing APPs in the hospital, urgent care locations, and primary care practices.

Christina notes most APPs have graduated from at least a master’s-prepared degree program and pride themselves on team collaboration with colleagues in managing patients.

“It has been demonstrated, and evidence supports, the high quality and safe care APPs bring to patients,” Christina said. “Our role in the community is more important now than ever as we provide improved access for our patients seeking healthcare.”

John, who first joined Thompson in 2003, is an associate professor in the PA program at the Rochester Institute of Technology.

He said that while PA education is based on the medical school model with PAs considered “generalists,” NP education is based on advanced practice nursing with NPs choosing a specialty. The two roles are so similar, he said, that an APP job posting is most often open to both PA and NP applicants.

In New York State, NPs with more than 3,600 hours of experience can practice independently due to the passage of the Nurse Practitioners Modernization Act. In addition, under the state’s public health emergency during the pandemic, PAs have not been required to collaborate with a physician; there is legislation pending which would make this permanent.

For example, in a primary care setting APPs – including certified nurse midwives – can:

• Provide comprehensive evaluations, physical exams, and checkups
• Diagnose and manage acute and chronic conditions
• Prescribe medications
• Order, perform, and interpret diagnostic imaging studies and lab work
• Provide immunizations
• Promote wellness
• Refer patients to specialist physicians when necessary

John echoed Christina in noting the increased reliance on APPs throughout the country is all about promoting access to care and working with physicians and other healthcare professionals. APPs can completely manage some cases, he said, and with others, they can begin the process and then refer the patient to a physician.

“It’s a team, and there’s a role for everybody with patients at the center,” he said. “We work well together in the trenches because we’re all just here to provide quality patient care.”

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